Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 6803T | TX |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 6803T | TX |
NPI | 1134291891 |
---|---|
Provider Name | Dr. Marvin W Brown III |
First Address | Arlington, TX 76016-1522 |
Second Address | Waxahachie, TX 75165-5114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 19/01/2011 |